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Acute medicine services are improving outcomes

Acute medicine is one of the youngest and fastest growing medical specialities which is playing an increasingly important role in improving patient outcomes.

Hospitals began appointing specialists in acute medicine from the late 1990s to cope with a progressive increase in emergency medical admissions, a requirement to reduce junior doctors’ hours and to meet patient expectations for consultant-led care.

It was also realised that a new breed of specialist acute medicine physician was needed to fill the gap left by hospital consultants becoming more specialised and spending less time on general medicine.

The Society for Acute Medicine (SAM) was formed in 1999 to provide support for these new specialists and acute medicine has now been approved as a specialty in its own right. SAM was launched by a handful of consultants and now has a membership of over 450. The number of acute medical units (AMUs) across the UK has grown to 225.

Specialist acute physicians are driving forward changes in the management of patients on the AMU, and several hundred specialist registrars are now training on the newly approved Curriculum in Acute Internal Medicine.

A landmark document called Quality Standards for Acute Medical Units, was launched in June to help trusts achieve consistency in the quality and standards of care for patients admitted as an emergency.

Dr Chris Roseveare, president of the Society for Acute Medicine, and an acute medicine consultant at Southampton University Hospitals NHS Trust, says: “What we are trying to do is provide a framework so that models of care are consistent across all units. This will enable people working in AMUs to benchmark themselves against each other and will show patients that the quality of care they are getting in their local hospital is as high as in any other part of the country.”

The standards emphasise the key role of specialists. The document stipulates that a consultant should be present on the AMU for at least 12 hours a day 7 days a week. Many units meet or exceed this but others struggle to meet that target because they don’t have adequate numbers of consultants to provide that level of care.

Dr Roseveare says there is no longer any question that a seven day service improves outcomes for patients. “It’s not acceptable to have a different level of care at weekend than on a weekdays – that is something we are very keen to promote. If your outcomes are better then that will improve your cost effectiveness and if you can get patients out of hospital more quickly because they are being seen more rapidly by a consultant then you can reduce your overall bed capacity and that will result in financial savings.”

The standards stipulate that a patient should be seen by a competent clinician within four hours and by a consultant within 14 hours of arrival at the unit. Many hospitals are already achieving that figure. National data shows that over 80% of patients are being seen in that time and in some hospitals it is as high as 95%.

“We are very encouraged that things are moving in the right direction. The speciality has developed and moved on since 1999 which is a very good thing for patient care. It means that when patients first come in to hospital they are now more likely to see someone senior and more likely to get an appropriate diagnosis made and more likely to get the right treatment.”

But Dr Roseveare says there is still a lot to do. The acute medicine workforce needs to expand to achieve the 12-hour 7-day consultant presence standard on AMUs across the country. Also the specialty needs more junior doctors to specialise in emergency and acute care. SAM is currently working with the Royal College of Physicians to develop sustainable models of consultant working practice to encourage more doctors to consider the specialty as a career option.

Dr Roseveare says the specialty is continuing to develop at a rapid pace. “In ten years time I would like to see acute medicine being a consultant-led 7-day specialty with enough consultants to be able to provide that across the UK. I would also like to see the acute medicine specialist playing a role in the ongoing management of general medicine patients on the wards. There is an enormous void at the moment in hospital medicine with the loss of the generalist and there is clearly a need for consultants to pick up the management of patients who don’t fall into any clear cut specialist category after they leaving the AMU.”

To attend the Society for Acute Medicine’s conference in Manchester in October click here.

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